Applications of ECM analogs in surgery.

The loss of tissue mass in humans has been conventionally treated as an irreversible change. Treatments have emphasized replacement of the missing function by use of a transplant, an autograft, tissue synthesized in vitro or, most commonly, by use of engineering devices based on biomaterials. During the last few years solid progress has been made in the area of tissue and organ regeneration. This new approach is based on the discovery that certain simple chemical analogs of extracellular matrices synthesized by graft copolymerization of a glycosaminoglycan onto type I collagen can induce synthesis of physiologic tissue in lesions which otherwise heal spontaneously by synthesis of scar tissue. This approach offers serious potential advantages over the alternatives listed above since the graft "grows out" of host tissue. However, regeneration in the adult mammal has been successfully demonstrated so far only in skin (human, guinea pig), sciatic nerve (rat) and the knee meniscus (dog).